* Denotes mandatory field. Enter one, or both of home phone or mobile phone.

Contact Details

Title

*

First Name

*

Last Name

*

Email

*

Mobile Phone

Enter mobile number in format 0412 345 678

Home Phone

Enter number with area code: 02 2345 6789

Request

Model

Registration Number

*

Vehicle Identification Number (VIN)

(Can be found on your car registration)

*

Summary of Relevant Information

Privacy Collection Statement

Nissan Motor Co. (Australia) Pty Ltd (Nissan) respects your privacy.

We will only use the information you provide for the purposes of processing and fulfilling your request or enquiry and, if you have consented on this form, sending you marketing material which may be of interest to you. We may disclose your information to an authorised Nissan dealer, our related companies and/or third parties associated with us for these purposes.

Our Privacy Policy contains further details regarding how you can access or correct information we hold about you, how you can make a privacy related complaint, how that complaint will be dealt with and the extent to which your information may be disclosed to overseas recipients.

Do not remove this section. Reqd for saving form as SCV xml. Will be a hidden field